U.S. patent number 6,048,902 [Application Number 09/249,386] was granted by the patent office on 2000-04-11 for short contact treatment of psoriasis with topical retinoids.
Invention is credited to Susan Bershad, Mark G. Lebwohl.
United States Patent |
6,048,902 |
Lebwohl , et al. |
April 11, 2000 |
Short contact treatment of psoriasis with topical retinoids
Abstract
The present invention relates to a method of treating psoriasis
using short-term contact with a topically-applied retinoid
composition.
Inventors: |
Lebwohl; Mark G. (New York,
NY), Bershad; Susan (Montclair, NJ) |
Family
ID: |
22943255 |
Appl.
No.: |
09/249,386 |
Filed: |
February 12, 1999 |
Current U.S.
Class: |
514/725 |
Current CPC
Class: |
A61K
31/192 (20130101); A61K 31/203 (20130101); A61K
31/4436 (20130101) |
Current International
Class: |
A61K
8/30 (20060101); A61K 8/67 (20060101); A61K
31/192 (20060101); A61K 31/203 (20060101); A61K
31/185 (20060101); A61K 31/4427 (20060101); A61K
31/4436 (20060101); A61K 001/04 () |
Field of
Search: |
;514/474,725 ;435/6 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Leyden, James J., Emerging Topical Retinoid Therapies, Journal of
the American Academy of Dermatology, Apr. 1998, vol. 38, No. 4, pp.
S1-S4. .
Chandraratna, R., Tazarotene--first of a new generation of
receptor-selective retinoids, British Journal of Dermatology 1996,
vol. 135, pp. 18-25. .
Azelex package insert by Allegan(manufacture), N/A. .
Retin-A package insert by Ortho-Derm(manufacture), N/A. .
Allergan Tazorac Plaque psoriasis . . . , Tpink sheet: FDC report,
vol. 59/25, Jun. 1997. .
Tazorac package insert by allergan(manufacture), N/A. .
Lavker et al., An Ultrastructural study of the effects of topical
tretinoin . . . , vol. 14(6), pp. 773-780, 1992..
|
Primary Examiner: MacMillan; Keith D.
Assistant Examiner: Kim; Vickie
Attorney, Agent or Firm: Kenyon & Kenyon
Claims
We claim:
1. A method of treating psoriasis in a human patient comprising the
steps of (1) topically applying an effective amount of a retinoid
composition to the affected area of a patient's skin; (2) allowing
said composition to remain in contact with the skin for a period of
from about thirty seconds to about thirty minutes; and (3) rinsing
said retinoid composition from said affected area.
2. The method according to claim 1 wherein said composition remains
in contact with the skin for a period of from about two to about
ten minutes.
3. The method according to claim 1 wherein said retinoid
composition comprises tretinoin, tazarotene or adapalene as the
topically active retinoid.
4. The method according to claim 2 wherein said retinoid
composition comprises tretinoin tazarotene or adapalene as the
topically-active retinoid.
5. The method according to claim 3 wherein said topically-active
retinoid is present in an amount of about 0.01% to about 10% by
weight.
6. The method according to claim 4 wherein said topically-active
retinoid is present in an amount of about 0.01% to about 10% by
weight.
7. The method according to any one of claims 1-6, wherein steps (1)
to (3) are carried out at least 3 times per week.
8. The method according to claim 1, wherein said retinoid
composition comprises tazarotene as a topically-active
retinoid.
9. The method according to claim 2, wherein said retinoid
composition comprises tazarotene as a topically-active
retinoid.
10. The method according to claim 8, wherein said topically-active
retinoid is present in an amount of about 0.01% to about 10% by
weight.
11. The method according to claim 9, wherein said topically-active
retinoid is present in an amount of about 0.01% to about 10% by
weight.
12. The method according to any one of claims 8-11 wherein steps
(1) to (3) are carried out at least 3 times per week.
Description
BACKGROUND OF THE INVENTION
The present invention is directed to the treatment of psoriasis
using topical retinoids.
The retinoids are a family of compounds including vitamin A,
retinoic acid (RA), related derivatives of these, and other
compounds capable of binding to retinoic acid receptors (RAR). RA,
which is a natural metabolite of vitamin A (retinol), is known as a
potent modulator (i.e., an inhibitor or, to the contrary, a
stimulator, depending on the nature of the cells treated) of the
differentiation and proliferation of many normal or transformed
cell types. All-trans-RA (tretinoin) acts on the differentiation
and proliferation of cells by interacting with RARs contained in
the cell nucleus. There are, to date, three identified subtypes of
known RAR receptors, respectively termed RAR-.alpha., -.beta.,
-.gamma.. These receptors, after binding the RA ligand. interact
with the promoter region of genes regulated by RA at specific
response elements. To bind to the response elements, the RARs
heterodimerize with another type of receptor designated as RXR. The
natural ligand of RXRs is 9-cis-retinoic acid.
Many retinoids are known and have been described to date.
Generally, retinoids can be identified by their ability to bind
RARs, either as all the RARs or selectively to an individual RAR
class. Further, retinoids exhibit a diverse spectrum of activities.
Among these is use as a topical therapeutic for treatment of skin
conditions.
There is presently in use an FDA approved treatment for psoriasis
employing tazarotene topical gel that is marketed by Allergan, Inc.
under the brand name Tazorac.TM.. Moreover, tretinoin, also known
by the tradename Retin-A.TM., and adapalene are approved for
topical use to treat skin conditions.
The mechanism of action in the treatment of psoriasis with
tazarotene or other retinoids is not known. The current
FDA-approved therapeutic regimen requires Tazorac.TM. gel to be
applied topically in its 0.05% or its 0.1% formulation and left on
the affected skin for long periods of time, e.g. overnight. It is
generally applied in the evening and left in place until routine
washing in the morning. Thus, in the treatment of psoriasis, the
Tazorac.TM. gel would typically be left on the skin for 8 to 12
hours.
Unfortunately, a major shortcoming of this course of treatment is
that adverse skin reactions are experienced by a significant
portion of users. These reactions include pruritus,
burning/stinging and erythema (sometimes severe), actual worsening
of psoriasis, irritation and skin pain. Since the treatment regimen
is usually prolonged, covering many weeks or months, any adverse
reactions are rendered even more substantial in the perception of
the user, often resulting in the interruption or abandonment of the
treatment regimen. Thus the adverse reactions are not merely
significant in-and-of themselves, but can make treatment
ineffectual due to the inability or unwillingness of the user to
follow the regimen.
To overcome these shortcomings, it has now been found that
topically-applied retinoids can be used to treat psoriasis using a
short-contact treatment regimen. For example. tazarotene has been
used for short-contact therapy to treat psoriasis as disclosed in
co-pending application entitled "Short Contact Treatment of
Psoriasis with Tazarotene Compositions," filed on the same day as
this application by the same inventors and which is hereby
incorporated herein by reference.
SUMMARY OF THE INVENTION
The present invention is directed to a method of treating psoriasis
in a human patient by topically applying an effective amount of a
retinoid composition to the affected area of a patient's skin,
allowing that composition to remain in contact with the skin for a
period of from about thirty seconds to about thirty minutes,
followed by rinsing the composition from the affected area.
Generally, the short contact treatment is performed once a day at
least three times a week as long as treatment is needed. In
preferred embodiments, the active retinoid in the composition is
tazarotene, tretinoin or adapalene and. more preferably, is
tazarotene.
DESCRIPTION OF THE INVENTION
According to the invention, it has been found that short-contact
retinoid therapy yields surprisingly improved and beneficial
results in the treatment of psoriasis.
"Short-contact retinoid therapy", as used herein, is intended to
distinguish over conventional, or extended-contact, treatment(s)
the retinoid of interest is applied to a patient's skin (typically
once a day) and left on the skin indefinitely or until routine
washing or showering occurs after a prolonged period of time
(typically overnight).
In accordance with the invention, short-contact retinoid therapy
thus comprises the steps of applying a retinoid composition to an
affected area of the skin for a brief time period followed by
rinsing of the skin/affected area. For psoriasis, the usual contact
time is from about 30 seconds to about 30 minutes, preferably for a
period of from about 5 to about 10 minutes. Immediately following
the prescribed period of time, the skin is rinsed thoroughly,
typically with lukewarm water.
For psoriasis therapy, the short-contact treatments are generally
applied to the affected area(s) once or twice a day, preferably
once a day, and repeated at least three times a week. If desired or
needed, the treatments can be repeated daily. The overall duration
of therapy is continued for as long as the conditions exist, i.e.,
until the plaques are gone or have disappeared, and can readily be
determined by the patient's doctor.
In accordance with the invention and as used herein, a "retinoid
composition" comprises therapeutically-active retinoids, or
pharmaceutically-acceptable salts thereof, in admixture with a
pharmaceutically acceptable carrier. The therapeutically-active
retinoids of the invention are selected from the group consisting
of a retinoic acid; retinol; therapeutically-active retinoic acid
derivatives; therapeutically-active carboxylic acids represented by
the formula ##STR1## and retinoids which are C20 or C22 desmethyl
vinylogs of said groups, wherein Z is a substituted or
unsubstituted phenyl group, a substituted or unsubstituted naphthyl
group or a cyclohexenyl group, and said phenyl or naphthyl group
can be substituted with from 0 to 5 substitutents selected from the
group consisting of halo, hydroxy, alkly, alkyoxy, amino, cyano or
carbalkoxy, and wherein double bonds in the polyene chain of any of
said groups can have a cis or trans configuration; acetylenic
retinoids; adapalene; adapalene derivatives and any compound,
natural or synthetic, which possesses the topical biological
activity of retinoic acid in the skin and/or the ability to bind to
one or more RARs; as well as the geometric isomers and steriosomers
of any of these compounds.
Examples of retinoids contemplated by the invention can be found in
U.S. Pat. Nos. 4,476,056; 4,105,681; 4,215,215; 4,054,589 and
3,882,244. Retinoids include both cis and trans forms having
therapeutic activity. The retinoids can include a 9-cis double
bond, a 13-cis double bond or a 13-trans double bond. Derivatives
of retinoic acid include, but are not limited to, esters, amides,
other biologically active forms of retinoic acid such as those with
a chemical modification or substitution of a substituent of the
molecule, and the like. Derivatives of adapalene include, but are
not limited to, esters and amides of the naphthoic acid moiety,
other biologically active forms of adapalene such as those having a
chemical modification or substitution on some part of the molecule
while retaining activity. and the like.
A pharmaceutically acceptable salt may be prepared for any compound
of this invention having a functionality capable of forming such
salt, for example an acid or amine functionality. A
pharmaceutically acceptable salt may be any salt which retains the
activity of the parent compound and does not impart any deleterious
or untoward effect on the subject to which it is administered and
in the context in which it is administered.
The preferred compounds of the invention include, but are not
limited to, retinoic acid including tretinoin, 13-cis retinoic
acid, 9-cis-retinoic acid, acetylenic retinoids including
tazarotene and adapalene.
As used herein a "therapeutically-active retinoid" is a compound
which, when applied topically, exhibits or possesses a biological
action similar to retinoic acid (i.e., similar to vitamin A acid).
Hence, these retinoids include those compounds, synthetic or
natural, which have one or more of the therapeutic activities known
for retinoic acid. Such activities include but are not limited to
binding to and activating RARs, treating and preventing cancer and
other proliferative disorders, acting as differentiating agents or
anti-proliferatives agents and anti-tumor activity.
As used herein "vinylogs" are desmethyl retinoyl groups having 1 or
2 additional vinyl groups relative to retinoic acid. For example
such compounds include
2,6,6-trimethyl-1-(10'-carboxy-deca-1',3',5',7',9'-pentaenyl)cyclohex-1-en
e and
2,6,6-trimethyl-1-(12'-carboxy-dodeca-1',3',5',7',9',11'-hexaenyl)cyclohex
-1-ene. These groups are also referred to as C20 and C22 vinylogs
of desmethyl retinoic acid and are described in U.S. Pat. No.
3,882,244. The vinylogs of this invention can be prepared from a
retinoyl group, any therapeutically active retinoid carboxyl group,
or any group of the formula ##STR2## wherein Z is as defined
herein.
The acetylenic retinoids of the invention are the compounds of the
formula represented by ##STR3## wherein X is S, O, or NR' where R'
is hydrogen or lower alkyl; R is hydrogen or lower alkyl; A is
pyridinyl, thienyl, furyl, pyridazinyl, pyrimidinyl or pyrazinyl; n
is 0-2; and B is H, --COOH or a pharmaceutically acceptable salt,
ester or amide thereof, --CH.sub.2 OH or an ether or ester
derivative, or --CHO or an acetal derivative, or --COR.sub.1 or a
ketal derivative where R.sub.1 is --(CH.sub.2).sub.m CH.sub.3 where
m is 0-4.
The term "ester" as used here refers to and covers any compound
falling within the definition of that term as classically used in
organic chemistry. Where A is --COOH, this term covers the products
derived from treatment of this function with alcohols. Where the
ester is derived from compounds where A is --CH.sub.2 OH, this term
covers compounds of the formula --CH.sub.2 OOCR where R is any
substituted or unsubstituted aliphatic, aromatic or
aliphatic-aromatic group.
Preferred esters are derived from the saturated aliphatic alcohols
or acids of ten or fewer carbon atoms or the cyclic or saturated
aliphatic cyclic alcohols and acids of 5 to 10 carbon atoms.
Particularly preferred aliphatic esters are those derived from
lower alkyl acids and alcohols. Here, and where ever else used,
lower alkyl means having 1-6 carbon atoms. Also preferred are the
phenyl or lower alkylphenyl esters.
The term "amide" has the meaning generally accorded that term in
organic chemistry. In this instance it includes the unsubstituted
amides and all aliphatic and aromatic mono- and di-substituted
amides. Preferred amides are the mono- and di-substituted amides
derived from the saturated aliphatic radicals of ten or fewer
carbon atoms or the cyclic or saturated aliphatic-cyclic radicals
of 5 to 10 carbon atoms. Particularly preferred amides are those
derived from lower alkyl amines. Also preferred are mono- and
di-substituted amides derived from the phenyl or lower alkylphenyl
amines. Unsubstituted amides are also preferred.
Acetals and ketals includes the radicals of the formula --CK where
K is (--OR).sub.2. Here, R is lower alkyl. Also, K may be
--OR.sub.1 O-- where R.sub.1 is lower alkyl of 2-5 carbon atoms,
straight chain or branched.
The preferred acetylenic retinoid compounds of this invention are
those where the ethynyl group and the B group are attached to the 2
and 5 positions respectively of a pyridine ring (the 6 and 3
positions in the nicotinic acid nomenclature being equivalent to
the 2/5 designation in the pyridine nomenclature) or the 5 and 2
positions respectively of a thiophene group respectively; n is 0;
and B is --COOH, an alkali metal salt or organic amine salt, or a
lower alkyl ester, or --CH.sub.2 OH and the lower alkyl esters and
ethers thereof, or --CHO and acetal derivatives thereof.
The preferred compounds include:
ethyl 6-(2-(4,4-dimethylthiochroman-6-yl)ethynyl)-nicotinate;
6-(2-(4,4-dimethylthiochroman-6-yl)ethynyl)nicotinic acid;
ethyl 6-(2-(4,4-dimethylchroman-6-yl)ethynyl)nicotinate;
ethyl
6-(2-(4,4,7-trimethylthiochroman-6-yl)ethynyl)-nicotinate;
ethyl
6-(2-(4,4-dimethyl-1,2,3,4-tetrahydroquinolin-6-yl)ethynyl)nicotinate;
ethyl
5-(2-(4,4-dimethylthiochroman-6-yl)ethynyl)thiophene-2-carboxylate;
6-(2-4,4-dimethylthiochroman-6-yl)-ethynyl)-3-pyridylmethanol;
and
2-(2-(4,4-dimethylthiochroman-6-yl)-ethynyl)-5-pyridinecarboxaldehyde.
The compounds of the invention can be purchased or made by methods
known in the art. One means to make such compounds is provided in
U.S. Pat. No. 5,089,509 which is hereby incorporated herein by
reference.
The "retinoid composition" contains the retinoid compounds of the
invention in amounts suitable for topical use on humans. Such
compositions may be in the form of a gel, cream lotion, ointment,
cleanser or solution and include a variety of preservatives,
carriers and other inactive or active ingredients.
As used herein, "therapeutically-effective amount" refers to that
amount of a therapeutically-active retinoid necessary to administer
to a human patient to treat psoriasis. Such amounts depend on the
retinoid and its bioavailability but can range from about 0.01% to
about 10% by weight, or preferably from about 0.025% to about 1-5%
by weight. For tazarotene, commercially available preparations of
0.05% and 0.1% are effective. Therapeutically-effective amounts can
be readily determined by one of ordinary skill in the art.
As demonstrated by the following examples, surprisingly good
results are obtainable using short-contact retinoid therapy. Not
only does it appear that there is no loss of effectiveness of the
active retinoid ingredient (as compared with conventional
extended-contact therapy), but also that the effectiveness may be
enhanced in some instances. Even more important, the adverse
reactions are substantially reduced to tolerable or even negligible
levels, thereby resulting in the ability and willingness of the
user to adhere to the novel regimen. This combination of effects,
i.e., equal or enhanced effectiveness, reduction in adverse
reactions, and regimen adherence, yields surprisingly improved
therapeutic efficacy.
EXAMPLE 1
Three patients were treated for psoriasis with short-contact
tazarotene therapy for a period of at least six weeks. The contact
period was from 30 seconds to 30 minutes followed by immediate
rinsing. All three patients showed greater than 75% reduction in
plaque thickness and scale. These results were significantly better
thatn those seen in corresponding plaques which were either
untreated (one patient) or treated with traditional phototherapy
(two patients). One of 3 patients noted minor irritation.
Short-contact tazarotene therapy for psoriasis has also been used
successfully on alternate-day and three-times-weekly schedules.
* * * * *